Ready-to-use food-allocation policy to reduce the effects of childhood undernutrition in developing countries

Abstract

Several aid groups have proposed strategies for allocating ready-touse (therapeutic and supplementary) foods to children in developing countries. Analysis is needed to investigate whether there are better alternatives. We use a longitudinal dataset of 5,657 children from Bwamanda to construct a bivariate time-series model that tracks each child's height-for-age z score (HAZ) and weight-forheight z score (WHZ) throughout the first 5 y of life. Our optimization model chooses which individual children should receive readyto-use therapeutic or supplementary food based on a child's sex, age, HAZ, and WHZ, to minimize the mean number of disabilityadjusted life years (DALYs) per child during 6-60 mo of age [which includes childhood mortality calculated from a logistic regression and the lifelong effects of stunting (i.e., low HAZ)] subject to a budget constraint. Compared with the strategies proposed by the aid groups, which do not use HAZ information, the simple strategy arising from our analysis [which prioritizes children according to low values of a linear combination of HAZ, WHZ, and age and allocates the entire budget to therapeutic (i.e., 500 kcal/d) food for the prioritized children] reduces the number of DALYs by 9% (for the same budget) or alternatively incurs the same number of DALYs with a 61% reduction in cost. Whereas our qualitative conclusions appear to be robust, the quantitative results derived from our analysis should be treated with caution because of the lack of reliable data on the impact of supplementary food on HAZ and WHZ, the application of our model to a single cohort of children and the inclusion and exclusion errors related to imperfect food targeting. U ndernutrition is often measured by wasting [weight-for-height z score (WHZ) below −2 according to World Health Organization (WHO) child growth standards (1)] and stunting [heightfor-age z score (HAZ) below −2]. Along with intrauterine growth restriction, wasting and stunting are estimated to account for over 21% of deaths and disability-adjusted life-years (DALYs) among the world's children under 5 y old (2). The prevalences of stunting and wasting are particularly high in the least developed countries and are 9% and 38% in Sub-Saharan Africa and 19% and 47% in South Asia (3). Ready-to-use therapeutic food (RUTF) has revolutionized the treatment of severe wasting (WHZ < −3) (4), which is often attributable to the transient effects of disease or food shortages. In contrast, stunting is attributable to chronic undernutrition, is more difficult to reverse, and has lifelong health, education, and economic effects (5). Moreover, although children with severe undernutrition have the greatest risk, the majority of mortality and morbidity stems from the mild [WHZ or HAZ ∈(−2, −1)] and moderate [WHZ or HAZ ∈(−3, −2)] forms of undernutrition (6). The success of RUTF has led to the introduction of ready-to-use supplementary food (RUSF), which provides less energy at a lower cost than RUTF and enriches a child's existing diet with the goal of treating ...

Multi‐Treatment Inventory Allocation in Humanitarian Health Settings under Funding Constraints

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